Really stupid question because I'm stupid. But are the rates the same whether service was rendered by Pod vs. Ortho?
Its not a stupid question. My experience joining an IPA and seeing schedules has sort of recalibrated my opinion on how money is made. Some of the answers above are slightly different than mine and that's ok - all things are possible. I've sort of believed for the longest time everyone was getting paid except me. In the end - all you can do is make hay while the sun is shining under the terms of your own town.
The question on a lot of people's minds is - why do we make what we make while other fields keep so much more of the money. My feeling having practiced longer is the following - and I'm not going to touch on podiatrist-on-podiatrist-financial assault:
(a) There are insurances that pay podiatry less - both commercial and Medicare advantage.
-I've described previously a commercial insurance that seems to deliberately underpay podiatry specific codes. In fact, by joining my IPA I received a very detailed sheet that spells out the origin of the reimbursement value ie. whether its based on Medicare or something else and the podiatry common codes that were reduced had a marker next to them essentially stating they were invented ie. purposely reduced. Other codes on the sheet were very clearly based on Medicare and a positive multiplier.
-I had a small office based procedure to make sure I don't have to buy more carseats. I checked the codes they used and they were reimbursed better than I would have been, but not dramatically. This was by a specific predatory insurance that I both hate and unfortunately have as my office insurance. Ugh. Interestingly, their rates were less than my old rates ie. they got straight Medicare as the reimbursement for my procedure but I used to get 1.4X Medicare from this insurance. So - does this insurance suck for me? Yes. But it sucks for them too and seems to be on an overall downward trend for everyone ie. I used to get 40% more than they got from me.
-I've obviously also described previously the feeling that the commercial environment is deteriorating though it may not be deteriorating for others as fast as it is for us. I can only comment on what I'm experiencing. Perhaps its better elsewhere. There is a component of negotiation and I've had bad insurances offer 10% more here and there. Describing the benfits of my services, the cases I've already offered to help them, etc didn't seem to get any traction from insurance companies. I once wrote a long sheet explaining why I should be paid more and received back literally just the word "no". The simple truth is that for having all the data - insurance companies really have no idea who is valuable and who isn't. They are perfectly happy to pay a wound healing center to debride on their patients and skin graft them, forever. Do not believe for a second that insurance companies are smart or anything you ever hear about the future of payment being "quality" based. Its just obfuscation to reduce future payment.
(b) Other fields may be more likely to receive subsidy/call pay etc. That said, its potentially worth pointing out that this describes people who also "worker harder than us". Consider that none of the PP podiatrists in my town take call. I'm on a whatsapp group with some other podiatrists and apparently in bigger cities taking call for free is a real thing. Sorry big city pods... tackling cool cases...
(c) Other fields seem more likely to have facility ownership and the profit it generates.
(d)
And the kicker - most podiatrists are not doing enough straightforward lucrative work on profitable insurances. Too much work on Medicare and such, not enough on the good stuff. More on this later.
Government pays everyone the same. Theoretically everyone in the same IPA is being offered the same rates unless something in the individual contracts spells out something different. However, individual members of an IPA could theoretically go outside the IPA for specific insurances to try to acquire a better deal. The impression I've received from 2 IPAs now is that the largest health insurer in Texas pays everyone the same in private practice ie. same code, same pay. One of them specifically described for me a dermatologist calling and them telling him - we get the same you do. Interestingly, a certain payor I have the schedules for offers Primary Care Providers $3 more for E&M codes than specialists.
Here's my big thing. I don't think most podiatrists are doing enough good-payor-facility-surgery or enough good-payor-high profit in office procedures. I think there's too many of us and we dilute the good stuff. If everyone was doing 10+ matrixectomies a day and 5-7 surgeries on their surgery day - I think the overall collections for the profession would be a lot higher.
-Consider - you see a new patient for fungus. Let's just say its a 99203 - doesn't actually matter if its a 204 or not. This is still not a $300 encounter. Its variable $80 to $150ish bucks. It generates some version of 99213s-214s in the future. Its quick. There's nothing wrong with it. But while you are doing this the ophthos are banging out $500 lens every 15 minutes. That may not be a fair comparison, but the gist of things is podiatry does have things that can be profitable. I just think we aren't doing enough of them. We may not be able to match other specialities which have procedures that are profitable in bulk even on Medicare
-Consider 11056/11720. Over $100? Sure. Much risk? No. Perhaps you can do 3-4 of these in an hour. There's something to be said for that, but it doesn't stand up to doing 2 new 99203/11750 on good insurance in an hour and making over $700.
-Consider a wound care practice vs a everything practice. Medicare-good-insurance pay spectrum for 11042 is like $120-200 + E&M as needed. Plantar fascial injections range from like $50-90. Obviously one is risker, has more documentation etc. But the higher your acuity, theoretically the higher the codes and the better the reimbursement.
Where I'm going with this. I do think we're getting screwed. I do think big insurance looks down on us. But I've somewhat rearranged my views on insurance - the most common good insurance out there seems to be paying everyone the same. If that's the case - the only thing holding us down is what we're actually doing. As of late - the more good insurance surgery and procedures I do - the more money I make. But I don't do enough of them. I did a ton of flexor tenotomies at the beginning of this year. NONE of them were on good insurance. They were all Medicare and UHC-MA. The difference between that and good insurance would have been like $150-300 a procedure.
I repeat myself a lot but hopefully last thing - for all professions - try to come up with something they can do that is
(a) super common
(b) easy to do ie. can be done in 15-30
(c) and is profitable - ideally on Medicare but commercial insurance works too
Podiatry has some things that can somewhat fit all 3, but they may not match the possibilities of other professions.
